Meta‐analysis of risk factors for amputation in diabetic foot infections
Top Cited Papers
- 6 May 2019
- journal article
- research article
- Published by Wiley in Diabetes/Metabolism Research and Reviews
- Vol. 35 (7), e3165
- https://doi.org/10.1002/dmrr.3165
Abstract
Background Knowledge of risk factors is crucial to develop management and treatment protocols for the prevention of lower extremity amputation for patients with diabetic foot infections (DFIs). Methods We searched the research literature for studies reporting risk factors for lower extremity amputation in patients with DFI. The main outcome variables included both minor and major amputations. This study was reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines, and the protocol was registered in PROSPERO (CRD42018118543). Results A total of 2471 potential articles from the database search met the inclusion criteria. After reviewing the titles, abstracts, and full texts, remaining 25 articles were included in the final analysis. We identified 6132 patients with DFI in the 25 included articles. Of these, 1873 patients who underwent amputation were investigated. Male gender (odds ratio [OR]: 1.31), smoking (OR: 1.38), history of amputation (OR: 1.47), history of osteomyelitis (OR: 1.94), peripheral arterial disease (OR: 2.35), retinopathy (OR: 1.32), International Working Group on the Diabetic Foot (IWGDF) grades 3 and 4 (OR: 1.7 and 2.5), Wagner grades 4 and 5 (OR: 4.3 and 6.4), gangrene/necrosis (OR: 9.9), osteomyelitis (OR: 4.5), neuroischaemic DFI (OR: 3.06), severe infection (OR: 3.12), length of hospitalization (standardized mean difference [SMD]: 0.7), leukocytosis (OR: 1.76), mean erythrocyte sedimentation rate (ESR) (SMD: 0.5), mean C-reactive protein (CRP) (SMD: 0.8), tissue culture positivity (OR: 1.61), and isolation of Gram-negative bacteria from tissue culture (OR: 1.5) were found as predictors of amputation in DFI. Conclusions The present study highlighted some differences in diabetic foot ulcers and DFIs in terms of risk factors for lower extremity amputation. These data provide detailed information about risk factors for amputations among patients with DFI, thus contributing to the creation of new classification systems for assessment of high-risk patients.Keywords
This publication has 39 references indexed in Scilit:
- Diabetic foot infections: state‐of‐the‐artDiabetes, Obesity and Metabolism, 2013
- Executive Summary: 2012 Infectious Diseases Society of America Clinical Practice Guideline for the Diagnosis and Treatment of Diabetic Foot InfectionsaClinical Infectious Diseases, 2012
- 2012 Infectious Diseases Society of America Clinical Practice Guideline for the Diagnosis and Treatment of Diabetic Foot InfectionsaClinical Infectious Diseases, 2012
- Diabetic Foot Infections and the Role of Doppler USG in PrognosisTurkiye Klinikleri Journal of Medical Sciences, 2012
- Surgical Treatment of Limb- and Life-Threatening Infections in the Feet of Patients With Diabetes and at Least One Palpable Pedal PulseThe International Journal of Lower Extremity Wounds, 2011
- Developing and Validating a Risk Score for Lower-Extremity Amputation in Patients Hospitalized for a Diabetic Foot InfectionDiabetes Care, 2011
- Management of patients hospitalized for diabetic foot infection: Results of the French OPIDIA studyDiabetes & Metabolism, 2011
- Predictive factors for lower extremity amputations in diabetic foot infectionsDiabetic Foot & Ankle, 2011
- C-reactive protein as an outcome predictor for percutaneous transluminal angioplasty in diabetic patients with peripheral arterial disease and infected foot ulcersDiabetes Research and Clinical Practice, 2010
- Independent risk factors for amputation in diabetic footInternational Journal of Diabetes in Developing Countries, 2008